Funk, Tracy

Funk, Tracy is an individual health care provider with primary practice located at 3303 Sw Bond Ave # 16D Ohsu Department Of Dermatology, Portland OR 97239-4501. She recently has 3 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Pediatrics, Student, Health Care / Student in an Organized Health Care Education/Training Program, Allopathic & Osteopathic Physicians / Dermatology. Allopathic & Osteopathic Physicians / Dermatology is her primary health care specialty. Funk, Tracy can be contacted via phone (503) 418-3376.

Contact Information

Primary practice address
3303 Sw Bond Ave # 16D Ohsu Department Of Dermatology Portland OR 97239-4501
Phone: (503) 418-3376
Fax: (503) 346-8106
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Pediatrics 208000000X 47554 Colorado
Student, Health Care / Student in an Organized Health Care Education/Training Program 390200000X 47554 Colorado
Allopathic & Osteopathic Physicians / Dermatology 207N00000X 173370 Oregon

Profile Details

NPI number 1053536268
LBN Legal business name Funk, Tracy
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Apr 14th, 2007
Last updated Jun 17th, 2015 - about 11 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1053536268 NPPES
Colorado MEDICAID 82253862

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